Cystic lesions of the pancreas: Changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period Journal Article
| Authors: | Gaujoux, S.; Brennan, M. F.; Gonen, M.; D'Angelica, M. I.; DeMatteo, R.; Fong, Y.; Schattner, M.; Dimaio, C.; Janakos, M.; Jarnagin, W. R.; Allen, P. J. |
| Article Title: | Cystic lesions of the pancreas: Changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period |
| Abstract: | Background: Cystic lesions of the pancreas are being identified more frequently, and a selective approach to resection is now recommended. The aim of this study was to assess the change in presentation and management of pancreatic cystic lesions evaluated at a single institution over 15 years. Study Design: A prospectively maintained registry of patients evaluated between 1995 and 2010 for the ICD-9 diagnosis of pancreatic cyst was reviewed. The 539 patients managed from 1995 to 2005 were compared with the 885 patients managed from 2005 to 2010. Results: A total of 1,424 patients were evaluated, including 1,141 with follow-up >6 months. Initial management (within 6 months of first assessment) was operative in 422 patients (37%) and nonoperative in 719 patients (63%). Operative mortality in patients initially submitted to resection was 0.7% (n = 3). Median radiographic follow-up in patients initially managed nonoperatively was 28 months (range 6 to 175 months). Patients followed radiographically were more likely to have cysts that were asymptomatic (72% versus 49%, p < 0.001), smaller (1.5 versus 3 cm, p < 0.001), without solid component (94% versus 68%, p < 0.001), and without main pancreatic duct dilation (88% versus 61%, p < 0.001). Changes prompting subsequent operative treatment occurred in 47 patients (6.5%), with adenocarcinoma identified in 8 (17%) and pancreatic endocrine neoplasm in 4 (8.5%). Thus, of the 719 patients initially managed nonoperatively, invasive malignancy was identified in 12 (1.7%), with adenocarcinoma seen in 1.1%. Conclusion: Cystic lesions of the pancreas are being identified more frequently, yet are less likely to present with concerning features of malignancy. Carefully selected patients managed nonoperatively had a risk of malignancy that was equivalent to the risk of operative mortality in those patients who initially underwent resection. © 2011 American College of Surgeons. |
| Keywords: | clinical feature; histopathology; patient selection; treatment planning; comparative study; pancreas resection; follow up; prospective study; cystadenoma; intraductal papillary mucinous tumor; pancreas cyst; systematic review; conservative treatment; surgical risk; pancreas adenocarcinoma; surgical mortality; intermethod comparison; pancreas islet cell tumor; surgical patient; pancreas pseudocyst; pancreas duct ligation; pancreatography; stomach partitioning |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 212 |
| Issue: | 4 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2011-04-01 |
| Start Page: | 590 |
| End Page: | 600 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2011.01.016 |
| PROVIDER: | scopus |
| PUBMED: | 21463795 |
| PMCID: | PMC3817568 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 23 June 2011" - "CODEN: JACSE" - "Source: Scopus" |
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